The association between nutritional intakes and growth trajectories among infants with congenital diaphragmatic hernia: A retrospective cohort study

Abstract

Background

Congenital diaphragmatic hernia is a critical neonatal condition frequently associated with growth impairment. Nutritional strategies to support adequate growth remain poorly defined.

Objective

To evaluate the association between caloric and protein intake, timing of parenteral and enteral nutrition, and changes in anthropometric z-scores during neonatal hospitalization in infants with congenital diaphragmatic hernia.

Methods

Retrospective cohort study including infants with congenital diaphragmatic hernia who underwent surgical repair at a single center between 2018 and 2023. Data were collected from birth to discharge or 12th week of hospitalization. Weekly deltas in anthropometric z-scores—weight-for-age, length-for-age, and head circumference-for-age—were calculated. Daily caloric and protein intakes were estimated and averaged weekly; timing of parenteral and enteral nutrition and disease-related factors were obtained and associations with anthropometric z-score deltas were analyzed.

Results

A total of 117 infants were included. Overall, 65% experienced z-score declines ≥0.8 across all anthropometric z-scores. Receiver operating characteristic (ROC) curve analysis identified a caloric intake of 113 kcal/kg/day as predictive of positive weight-for-age z-score deltas (area under curve 0.67) with improved specificity at 118 kcal/kg/day. In multivariable linear mixed-effects model, higher caloric intake (p < 0.001) and longer duration of mechanical ventilation (p = 0.01) were independently associated with positive weekly weight-for-age z-score deltas. Additionally, higher caloric intake was independently associated with positive weekly head circumference-for-age z-score deltas (p = 0.02).

Conclusions

Growth impairment during hospitalization was highly prevalent among infants with congenital diaphragmatic hernia. A caloric intake of at least 113 kcal/kg/day, with an optimal threshold near 118 kcal/kg/day, may help prevent further deterioration in weight status.